Practice In Denmark Research Articles

Usage of Antimicrobials in Equine Veterinary Practice in Denmark – A Case-Based Survey

Horses may be carriers of important resistant bacteria like methicillin-resistant staphylococci. Such bacteria can potentially threaten both equine and public health, but little is known about predisposing factors like antimicrobial usage patterns in equines. Objectives of this study were to investigate the antimicrobial usage practices by Danish equine practitioners as well as factors impacting usage. A total of 103 equine practitioners filled in an online questionnaire. When asked to explain their typical treatment of six clinical case scenarios, only 1% and 7% of respondents prescribed systemic antimicrobials for a cough and pastern dermatitis, respectively. More frequent usage was reported for diarrhoea (43%), extraction of a cracked tooth (44%), strangles (56%), and superficial wound near a joint (72%). Among the antibiotics indicated for treatment, enrofloxacin was the only critically important antimicrobial agent reported by two respondents. Thirty-eight (36%) respondents worked in practices with antimicrobial protocols. When asked to prioritize the most important factor influencing prescribing habits, bacterial culture (47%) and antimicrobial protocols (45%) were selected far more often than the owner´s economy (5%) and expectations (4%). Veterinarians reported limitations such as the availability of only one oral antibiotic (sulphadiazine/trimethoprim), and a need for clearer treatment guidelines. In conclusion, the study highlighted important aspects regarding antimicrobial usage among equine practitioners. Antimicrobial protocols and pre- and post-graduate education on prudent antimicrobial usage are recommended.

Management of child maltreatment suspicions in general practice: a mixed methods study

Background Maltreated children have many long-term consequences throughout their lives, but often maltreated children are not recognised in time by professionals. General practice could be central to the early recognition of child maltreatment due to the long-term relationship with families. Objective How do general practitioners (GPs) and practice nurses (PNs) deal with suspected maltreatment in children below 18 years of age, and which factors influence them to report cases to social authorities. Design and setting A mixed methods study set in general practice in Denmark. Method and subjects We combined data from a nationwide questionnaire with observations from five clinics and 20 interviews with GPs and PNs. We explored our data using the concept of uncertainty as a driver that shapes action and decision-making in general practice. Results Most GPs (94%) said they would discuss cases of suspected child maltreatment with social services, but in many cases they would prefer to discuss their suspicions with a colleague first (83%) – most likely where there are no clear-cut signs. The qualitative data added nuance to these findings by highlighting the difficulty of communicating across sectors, the importance of maintaining a connection with the child’s family, and practicing watchful waiting. Conclusion General practice has an opportunity to act early in cases of suspected child maltreatment if uncertainty is accepted as a critical part of the process of reaching a diagnosis. Communication across sectors is key, as is support for GPs with suspicions and for families in need of help. Key points GPs are often thought to underreport child maltreatment but despite low levels of reporting, this does not mean they ignore it. Building on the connection with the family, making follow appointments, and discussing suspicions with colleagues are typical of how GPs manage suspicions of child abuse. Accepting uncertainty as a condition of raising the alarm could help GPs to act quickly to support children at risk of abuse.

Optimized number of suction cups required to predict annual nitrate leaching under varying conditions in Denmark

Nitrate concentrations in soil water leaving the root zone measured by suction cups combined with water transport modeling is a commonly used practice in Denmark for calculating nitrate leaching. Two suction cups installed in one plot giving one water sample and replicated four times, (eight total suction cups) to reduce variability between samples. For practical reasons, it would be beneficial to minimize the number of suction cups used yet maintain reliable predictions. To assess the variability in reducing suction replicates, this study analyzed data from five research sites across Denmark representing annual field nitrate leaching predictions for different combinations of soil, weather conditions, crops, N-fertilizer rates, and winter soil cover, covering a total of 173 annual nitrate leaching experiments. The analysis was conducted having different nitrate leaching predictions using different numbers of replicates of suction cup measurements. Linear regression was used to identify the different influences of leaching year (hydrological year), N rate applied, soil characteristics, and crop sequence on nitrate leaching. The analyses were set up on three 2-yr and two 3-yr field experiments in five different sites. Crop effects showed that cereals and winter cover sown in autumn 2017 had significantly more nitrate leaching than in 2015 and 2016 leaching years due to high precipitation rates in the autumn. Furthermore, decreasing the number of suction cup replicates from four (eight total) to three replicates (six total) did not have a significant effect on nitrate leaching prediction. In contrast, decreasing replicates from four to two (four total) and one (two total) replicates did show a significant difference. Therefore, using three replicates is a viable solution for future sampling strategies and a good trade-off between costs and accuracy.

Shared decision making in recurrent ovarian cancer: Implementation of patient decision aids across three departments of oncology in Denmark.

Patients with relapsed ovarian cancer are offered multiple treatment options. To match treatment with the individual patient's life situation and preferences, healthcare professionals can apply shared decision making (SDM) including patient decision aids (PtDAs).This study aimed to evaluate the implementation of two different PtDAs in consultations with patients suffering from relapsed ovarian cancer. We analyzed the following data before and after implementation of the PtDAs: 1) observed SDM using the OPTION instrument, 2) physician treatment recommendations, and 3) patients' and physicians' evaluations of SDM in consultations using the CollaboRATE, SDM-Q-9, and SDM-Q-Doc. Significant improvement in observed SDM was found after the implementation (p = 0.002). Improvement of SDM was detected in consultations conducted by physicians reporting more than two hours of SDM-training (p < 0.001), but not when physicians reported less than two hours of SDM-training.No before/after differences in treatment recommendations and in patients' and physicians' evaluations were found. Implementation of PtDAs improved the level of observed SDM. Training of physicians in SDM is necessary for improved SDM practice. Discussing oncological treatment options with the use of PtDAs is not standard practice in Denmark. The present study is one of the first Danish studies focusing on how to implement SDM and PtDAs in oncological consultations.

Cost-Utility of Venetoclax Plus Obinutuzumab for Treatment-Naïve Patients with Chronic Lymphocytic Leukemia without Del17p/TP53-Mutation Compared to Chlorambucil Plus Obinutuzumab

INTRODUCTION: Recently presented 6-year follow-up data from the CLL14 trial for chronic lymphocytic leukemia (CLL) showed increased overall survival (OS) and progression-free survival (PFS) using venetoclax plus obinutuzumab (VenO) as 1st line treatment when compared to chlorambucil plus obinutuzumab (ClbO) (Al-Sawaf, 2022). However, the higher treatment cost of VenO compared to off-patent chemotherapy requires evaluation of the potential trade-offs of added costs and improved health outcomes to inform decision-making. In Denmark, targeted agents are only reimbursed for treatment-naïve CLL patients with del17p/TP53-mutation. The objective of this study was to investigate the cost-effectiveness of VenO compared to ClbO in treatment-naïve CLL without del17p/TP53-mutation, including the course of disease until death. METHODS: A cost-utility analysis was conducted to simulate a hypothetical cohort of CLL patients with characteristics corresponding to the CLL14 cohort without del17p/TP53-mutation receiving either VenO or ClbO as 1st line treatment followed by either venetoclax plus rituximab (VenR) or ibrutinib (Ibr) as 2nd line treatment or no treatment after progression. Second line treatment was assumed to begin one month after progression. Model outcomes were the expected cost, quality-adjusted life-years (QALYs) and life-years (LY) per patient. Outcomes were used to calculate the incremental cost-effectiveness ratio (ICER) i.e. the added cost per extra QALY gained. A Markov model was constructed with a lifetime time horizon (Figure 1) and was set to replicate recently presented data for OS and PFS for 72 months from the CLL14 study. Parametric survival functions were estimated for the remaining life years, assuming a log-normal and exponential distribution for OS and PFS, respectively in the base-case. A Danish health sector perspective was applied with all costs estimated in EUR. Costs and quality of life decrements related to administration of both 1st and 2nd line treatment, as well as adverse event treatment, were included. Best available published data from the MURANO trial (VenR) (Kater et al., 2020) and Danish real-world evidence (Ibr) (Aarup et al., 2020) for 2nd line treatment was utilized to reflect current clinical practice in Denmark. Deterministic and probabilistic sensitivity analyses (PSA) were performed. Due to the absence of an official threshold of marginal cost per QALY in Denmark, results were compared to the British National Institute for Health and Care Excellence (NICE) threshold of GBP 20,000-30,000 (EUR 23,600-35,600). RESULTS: First-line treatment with VenO provided 5.28 QALY (7.54 LY) for the average patient compared to 3.80 QALY (6.12 LY) in the ClbO group (Table 1). Total costs per patient were EUR 202,821 for VenO and EUR 195,781 for ClbO, resulting in a base-case ICER of EUR 4,808 per QALY. The PSA showed that VenO was recommendable in 97% of the simulations at the lower NICE threshold. Results were robust to the assumptions on choice of 2nd line treatment, while exclusion of all costs and effects of 2nd line treatment showed cost-effectiveness results favoring ClbO. Cost of 2nd line treatment constituted up to 70% of the total patient cost, and especially the use of Ibr in 2nd line was associated with a higher total cost per patient. At a discount of 15% on the list price of venetoclax, 1st line VenO provided savings compared to ClbO. CONCLUSIONS: VenO was more effective in terms of QALY but at a higher cost than ClbO. VenO was cost-effective with inclusion of costs and effects of 2nd line treatment when using the NICE threshold indicating that VenO may also be cost-effective in Danish, and potentially other European, healthcare settings. While additional sensitivity analyses are awaited, these findings, along with previously published OS and PFS data, suggest that moving VenO into 1st line treatment may be beneficial and cost-effective also for patients without del17p/TP53-mutation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Diabetes and coronary risk equivalency – a population-based cohort study from Western Denmark

Abstract Background Diabetes is associated with an increased risk of cardiovascular disease. Accordingly, guidelines recommend extensive management of cardiovascular risk factors in patients with diabetes. Diabetes has previously thought to carry the same high cardiovascular risk as already having coronary heart disease. It is, however, unknown if the intensified focus on prophylactic treatment has changed the risk of myocardial infarction and ischemic stroke in contemporary practice. Aims We aimed to examine whether diabetes remains a cardiovascular risk equivalent to coronary heart disease under the contemporary treatment regimen. Methods We included every person residing in Western Denmark on January 1, 2012, aged 50–89 years. The cohort was stratified by diabetes and coronary heart disease (defined as previous myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or coronary artery disease documented by coronary angiography). The four groups were followed for up to seven years after inclusion. Outcomes were myocardial infarction, ischemic stroke, cardiac death, and all-cause death. Patients with coronary heart disease only were compared to patients with diabetes only using a multivariable Cox regression model. Results We included 1,111,456 persons residing in Western Denmark on January 1, 2012, of whom 86.1% had neither diabetes nor coronary heart disease, 7.5% had diabetes only, 5.0% only had history of coronary heart disease, 1.4% had both diabetes and coronary heart disease. Patients with diabetes only less likely to be in antithrombotic treatment, lipid-lowering treatment, and antihypertensive treatment compared to patients with coronary heart disease only. Compared to patients with diabetes only (Figure 1), coronary heart disease was associated with an increased risk of myocardial infarction (adjusted HR 1.73, 95% CI 1.65–1.82) and cardiac death (adjusted HR 1.40, 95% 1.32–1.48). However, coronary heart disease only was associated with a reduced risk of ischemic stroke (adjusted HR 0.83, 95% CI 0.79–0.87) and all-cause mortality (adjusted HR 0.76, 95% CI 0.74–0.77) compared to diabetes only (Figure 1). Conclusions In contemporary practice in Denmark, patients with diabetes only have a lower risk of myocardial infarction or cardiac death than observed in non-diabetic patients with verified coronary heart disease. On the contrary, patients with diabetes only have a greater risk ischemic stroke and al–cause mortality than coronary heart disease only. Thus, diabetes is not a uniform cardiovascular risk equivalent to coronary heart disease, but depends on the given outcome. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

Introducing quality clusters in general practice – a qualitative study of the experiences of cluster coordinators

BackgroundIn 2018, the concept of clusters was introduced as a new model for data-driven quality improvement in general practice in Denmark. However, there is little research on the development and implementation of general practice clusters. The study explores how the cluster coordinators responsible for leading the clusters forward enacted and experienced their role during the early years of the clusters with attention to the challenges and enablers perceived in the process.MethodsQualitative, semi-structured interviews with 25 cluster coordinators from clusters that had carried out at least two meetings on a specific professional topic. The coordinators represented clusters of varying sizes and different geographic locations. Key topics in the interview guide were the development and structure of the cluster, the role of the coordinator, obtainment of data for the meetings, the role of external support, the form and content of the meetings, the participation and engagement of the members. A thematic analysis – shaped by the original aims and categories of the study while also being open to emerging themes – was performed on the transcribed interview material.ResultsImportant enablers in the process of developing the clusters included the positive engagement of the GPs, the support offered by regional quality units and a national quality organisation for general practice, and the funding provided by the formal cluster framework. Challenges initially included setting up the clusters administratively and translating the open cluster concept into a local, workable model; and later obtaining relevant data for the cluster meetings and facilitating peer discussions about the data.ConclusionThe coordinators generally experienced that the development of the clusters had progressed relatively fast with engagement from most of the participating GPs. Still, challenges with data obtainment, data analysis, and facilitation will have to be addressed ongoingly. Future research should investigate learning processes at the cluster meetings and how the clusters impact clinical practice and collaborative relations between general practice and other health care providers.

When Borders Matter: Crafting Borders in a Participatory Artistic Project at Trapholt Museum

ABSTRACT In 2020, 778 embroiderers co-created a textile artwork at the Danish museum Trapholt. Textile artist Iben Høj developed the artistic design, and citizens contributed 713 embroideries, which Høj assembled in a huge mobile, exhibited at Trapholt 2020–21. The project, Stitches Beyond Borders, was part of a celebration of the cession of North Schleswig from Germany to Denmark in 1920. However, the project addressed not only the centenary but also invited the participants to reflect on other borders and boundaries. This combination—of a national celebration and an open theme of borders and boundaries—attracted our interest. For how would Stitches Beyond Borders combine a contested topic like borders with a national celebration? How would diverse and potentially antagonistic understandings of borders interact in the participatory process and product? Based on an analysis of diverse and rich empirical material, we relate these questions to the controversial socio-political bordering practices in Denmark and theories of borders, participation, and craft. We analyze a borderscape of competing meanings and conclude that although Stitches Beyond Borders was a highly successful participatory, artistic craft project, it only partly fulfilled its unique potential to address contemporary bordering practices and create alternative imaginaries, subjectivities and agencies. .

Impact of the Covid-19 pandemic on dental practices in Denmark

Objective To investigate the impact of the Covid-19 pandemic on the patient flow and economy as experienced by dental practices in Denmark. Material and methods A survey regarding experience of patient flow, economical turnover, financial strain and willingness to pay for large treatments during the first year of the Covid-19 pandemic (March 2020 to March 2021), along with information on the characteristics of the practice (specialist practice, ownership, practice operation and size) was distributed to all dental practices in Denmark in March 2021. Results Of the 1728 practices, 581 (33.6%) answered the survey. A decline in patient flow and a decline in economical turnover were reported by 79% and 84.4% of the practices, respectively. Financial strain was reported by 15.8% and an increased willingness to pay for large treatments was reported by 32.1%. A large decline in turnover and financial strain were associated with non-specialized practices, practices with a single owner and small practices. Logistic regressions showed that practices not receiving referrals had an odds ratio of 2.34 (CI: 1.32-4.14) for having a large decline in economic turnover compared with practices receiving referrals and that small practices had an odds ratio of 1.92 (CI: 1.16-3.19) for reporting financial strain compared with large practices. Conclusions Reportedly, the Covid-19 pandemic resulted in a decline in both patient flow and economical turnover in Danish dental practices. Large and more specialized practices seem to have managed the economic crisis better.

A cluster-randomized trial of a complex intervention to encourage deprescribing antidepressants in nursing home residents with dementia: a study protocol

BackgroundThe effectiveness of psychotropic medication on behavioral and psychological symptoms of dementia (BPSD) is limited, while associated with a higher risk of adverse events. Non-pharmacological treatment of BPSD is advocated as treatment of first choice. However, many general practitioners (GPs) find it difficult to initiate deprescribing, and when attempting to discontinue psychotropic medication in nursing home residents, they face many barriers. Therefore, we hypothesize that an intervention aimed at improving communication with and involvement of nursing home staff, relatives, and patients by GPs can optimize the pharmacological treatment of BPSD. The aim is to reduce the use of antidepressants in nursing home residents with dementia without increasing morbidity or mortality.ObjectiveThe primary outcome is reduction of antidepressant. Secondary outcomes include difference in use of other psychotropic medication, mortality, morbidity, and severity of BPSD.MethodThe study is a cluster-randomized controlled trial based in general practices in Denmark. We aim to include 22 practices, each of which will recruit up to 15 patients with dementia living in nursing homes. The intervention period is 3 months, and the total study period is 1 year. Randomization is 1:1 to intervention and control group by computer algorithm. Both groups receive education on BPSD and its evidence-based treatment. The intervention includes three tailored components; (1) teaching material and training to be used by the GP to educate nursing home staff on BPSD, (2) a pre-visit reflection tool to encourage nursing home staff to evaluate symptoms and reflect on relatives involvement in the discontinuation process; and (3) a dialog tool to facilitate shared decision making on optimization of BPSD treatment during the visits at the nursing home. The control group includes enhanced care as usual. The primary and secondary outcomes will be assessed at the end of the study period. A process evaluation will be conducted to assess the implementability.DiscussionWe anticipate that the intervention will optimize the treatment of BPSD with antidepressants for nursing homes residents and enhance compliance with reduction of medication. The process evaluation should provide insights into the barriers and facilitators to changing the current practice of deprescribing.Trial registrationClinicaltrials.gov NCT04985305. Registered on 30 July 2021.

General Practitioners' Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study.

Researchers aimed to describe general practitioners' understanding of appropriate ultrasound use, to record actual scanning practices of early adopters in general practice, and to identify differences between attitudes and actual practice via a mixed methods analysis. This study was part of a larger multistage mixed methods research framework exploring the use of ultrasound in general practice in Denmark. We used an exploratory sequential approach in the data collection with initial qualitative findings from an interview study applied to building a quantitative questionnaire utilized in a cohort study. In addition, we merged the qualitative and quantitative data using joint display analysis to compare and contrast the results from the 2 stages of the study. In the interviews, general practitioners described appropriate ultrasound use as point-of-care examinations with a clear purpose and limited to predefined specific conditions within delimited anatomic areas. They stated that general practitioners should receive formalized ultrasound training and be skilled in the examinations they perform. In the cohort study, general practitioners performed ultrasound examinations of anatomic areas with or without a defined clinical suspicion. Some performed ultrasound examinations for which they had no previous training or skills. We found a difference between the ideas about the appropriate uses for ultrasound in general practice and the actual use by early adopters in clinical practice. Our findings suggest a need for evidence-based guidelines to support general practitioners in choosing which examinations to perform and strategies for developing and maintaining scanning competency.

N19 Improving the standard of care for patients with IBD - translating the N-ECCO Consensus Statements

Abstract Background In 2018 the Second N-ECCO Consensus Statements were published in JCC and presented at the ECCO Congress. The statements aim to show the ‘ideal’ standard of care for patients with IBD and support IBD nursing practice. The statements comprise several sections: Fundamental IBD Nursing, Advanced IBD Nursing, and The benefit of an IBD Nurse. The Statements are presented in English and are available via the ECCO webpage. In order to raise awareness of the Statements and allow the Statements to be used in IBD nursing practice in Denmark, we aimed to translate the statements and to evaluate how the translated version were used. Methods Translation of statements into Danish by a physician who also is a journalist. Supported by the last author of the Statements (Bager). Distribution of the Statements to the Danish Community of IBD nurses. Open e-survey asking IBD nurses about the Danish version. Results Translation were done in autumn 2020. Promotion and distribution were done in spring 2021. This included 2 video recordings explaining the aim of the statements and how they could be used. Furthermore, the statements became online via our national organisation for IBD-nurses. The survey was launched in autumn 2021. As of November 22th. 2021, 16 nurses from across Denmark have responded. A large majority knew about the Danish version and aimed to use the Statements. However, implementation of the statements was delayed due to the covid-pandemic and a 10 weeks long strike among nurses in the summer of 2021. Furthermore, the responders highlighted the statements of most clinical importance. The top 5 most important statements were; 1) Fundamental IBD Nursing, 2) Impact of IBD on patients’ lives, 3) The Advanced IBD Nurse caring for complex patients, 4) The Advanced IBD Nursing assessment, and 5) Patient information and education. Conclusion Translation of the Second N-ECCO Consensus Statements into Danish was appreciated by IBD nurses in Denmark. A majority aimed to include the statements in the development of IBD nursing in clinical practice.

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

Background Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs). Aim To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process. Design and setting Qualitative study conducted in office-based general practice in Denmark. Methods Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study. Results The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training. Conclusion This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills. Key points Little is known about the educational needs of general practitioners striving to achieve ultrasound competences. General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills. Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

Socially distributed leadership in elementary schools: teacher and staff leadership practice in Denmark and the USA

PurposeThe purpose of this study is to examine the nature of socially distributed leadership in Denmark and the USA, specifically teacher and staff leadership practices distributed in schools.Design/methodology/approachThis study used a confirmatory factor analysis and a second-order factor analysis to examine elementary USA and 0–9 Danish school educators’ responses to the Comprehensive Assessment of Leadership for Learning.FindingsFindings from this analysis of leadership practice demonstrate (1) different approaches to teacher and staff leadership in Denmark and the USA; (2) the importance of a collaborative approach to developing and maintaining professional learning communities in schools in both contexts; and (3) different patterns of leadership practice that broadly reflect the local structure and approach to school leadership while responding to external policy demands.Originality/valueDrawing on the globalization scholarship, which acknowledges the connection between global policy development and local spaces of implementation, this comparative international study allowed us to examine how policy ideas are parlayed into practice through the use of a shared assessment of leadership practice. The results of this study suggest that while the work of teacher and staff leadership is important and something that educators in Denmark and the USA are engaging in to advance the overall instructional mission of their schools, the approaches taken in each context are different and reflect a local-level negotiation between contextual cultural norms and policy expectations.

Parental feeding practices and parental involvement in child feeding in Denmark: Gender differences and predictors

Studies about fathers and feeding are scarce and little is known about predictors of parental involvement in child feeding and of paternal feeding practices. Therefore, this study aimed to examine possible differences between Danish mothers and fathers with regard to their feeding practices and involvement in feeding related tasks, and to assess possible parent-related predictors of parental practices and involvement. A total of 261 mothers and 321 fathers of pre-schoolers completed an online survey with items from validated questionnaires. Gender differences were observed; fathers reported using higher levels of coercive control practices, while mothers reported using higher levels of structure practices and autonomy support practices. Both mothers and fathers reported to be highly involved in feeding their child. Regressions showed that a higher concern for child weight and a higher motivation for child preference when buying food were linked to a higher use of coercive control practices while a higher motivation for health control when buying food, cooking confidence, feeding/general self-efficacy and perceived responsibility for feeding were linked to a higher use of structure and autonomy support practices. The results of this study provide valuable insight into maternal and paternal practices in Denmark and their determinants.

Malnutrition measured by unintended weight loss among patients in general practice

Objective: Disease-related malnutrition should be managed before negative consequences occur. The aim of this study was to investigate the prevalence of unintended weight loss and reduced food intake among patients ≥18 y of age attending a general practice.Methods: All patients visiting five general practices in Denmark, for 4 d in each place, were invited to participate in this questionnaire-based cross-sectional study. The questionnaire consisted of eight questions including unintended weight loss within the previous 2 mo, reduced food intake within the previous week, and symptoms that affected nutrition. Descriptive statistics, χ2 tests, and simple and multivariable logistic regression analysis were performed. The study included 1087 patients with an 88.7% response rate.Results: Unintended weight loss was found in 14.2% and 12.9% had reduced food intake. Of the patients with unintended weight loss, 62.3% also had reduced food intake. Patients 18 to 39 and >80 y of age; underweight patients; and patients visiting general practice for chronic pain, mental discomfort, and suspicion of serious illness had significantly higher odds for unintended weight loss and reduced food intake. Patients with reduced food intake had higher odds for unintended weight loss, and those visiting the general practice due to fatigue had higher odds for reduced food intake. Patients in obesity class 1 to 3 and patients who had come for a general health checkup had lower odds. Patients visiting for follow-up on chronic physical illness had higher odds of having unintended weight loss and reduced food intake combined.Conclusion: Overall, 14.2% of the patients had unintended weight loss, 12.9% had reduced food intake, and 62.3% had both, indicating a high prevalence of unintended weight loss among patients in general practice. Unintended weight loss seems relevant and feasible to use as an initial indicator for the need for further nutritional screening in general practice. Studies are needed to investigate the effect of interventions and outcomes.

Socialising of nursing students into homecare practice in Denmark: a Berger and Luckmann-inspired interview study

In 2016, Denmark's nurse education eliminated diagnoses, age and care settings from the curriculum. How students are trained for homecare is unknown. This article illuminates how students of non-Danish origin were socialised into homecare practice during nurse education in Denmark. Semi-structured interviews with eight students and a theoretical inspired latent thematic analysis of data were conducted. The SRQR checklist was used. The results are presented under three themes: Unprepared students stepped out from university college, Clinical supervisors as instructive and questioned role models, and Patients and relatives acted as co-supervisors. Theoretical highlights on homecare nursing were scarce from students’ perspectives. Clinical supervisors and encounters with patients and relatives in their homes socialised students into professional roles within homecare. The organisation of education in homecare pointed to a clinical, professional socialisation of nursing students in patients’ homes rather than a theoretical socialisation with an inherent formation at university college.

Changes in received quality of care for knee osteoarthritis after a multicomponent intervention in a general practice in Denmark.

ObjectiveFirst‐line treatment for patients with knee osteoarthritis should ideally prescribe patient education, exercise, and if needed, weight loss. In practice, however, adjunctive treatments, including painkillers and referrals to specialists, are typically introduced before these measures. This study evaluated interventions to sustainably improve general practitioner delivered care for patients with knee osteoarthritis.DesignComparison of impacts of knee osteoarthritis care during four half‐year periods: before, 6, 12, and 18 months after primary intervention based on electronic medical records (EMR) and patient questionnaires.SettingDanish general practitioners (GPs) treating 6240 patients.ParticipantsFour GPs, two GP trainees, and six staff members.InterventionsSix pre‐planned primary interventions: patient leaflet, GP and staff educational session, knee osteoarthritis consultation, two functional tests monitoring patient function, EMR phrase aiding consultation, and waiting room advertisement and three supportive follow‐up interventions.Main outcome measuresUsage of first‐line and adjunctive treatment elements, the functional tests, and the EMR phrase.ResultsApproximately 50 knee osteoarthritis cases participated in each of the four half‐year periods. Primary interventions had only transient effects lasting <12 months on the knee osteoarthritis care. Functional tests and EMR phrases were used predominantly during the first 6 months, where a transient drop in the referral rate to orthopedics was observed. Use of educational elements was moderate and without significant change during follow‐up.ConclusionMore routine use of the primary or inclusion of novel increased‐adherence interventions is needed to sustainably improve care for knee osteoarthritis patients in Danish general practice.

Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study

Objective To assess (i) the pattern of antibiotic prescribing in Danish general practice, (ii) the use of diagnostic tests [point-of-care (POC) and tests analysed at the hospital laboratory (laboratory tests)], and (iii) the frequency of diagnostic testing in relation to antibiotic prescriptions. Design Retrospective cross-sectional register-based study. Setting General practice in a geographical area of Denmark covering 455,956 inhabitants. Subjects We studied redeemed antibiotic prescriptions and performed diagnostic tests in general practice from 2013 to 2017 among inhabitants in nine selected municipalities. Main outcome measures Frequency of antibiotic courses. Frequency and type of diagnostic testing performed in relation to types of antibiotics. Results A total of 783,252 antibiotic courses were redeemed from general practice with an overall decrease of 19% during 2013–2017. Diagnostic testing increased by 6% during this period. POC tests comprised the majority of performed diagnostic tests (83%) with C-reactive protein (CRP) as the most frequently used test. A 27% increase in the use of laboratory tests was observed. Tests were performed in relation to 43% of all antibiotic courses; most in relation to prescriptions for sulphonamide and trimethoprim (57%) and rarely when prescribing tetracyclines (10%). Conflicting with national guidelines, Danish GPs prescribed fluoroquinolones without performing any kind of diagnostic testing in 48% of the cases. Conclusions This study provides an overview of the use of diagnostic tests in relation to antibiotics and creates basis for further research into the variability between types of antibiotics. The study indicates that there is room for improvement to use diagnostic tests as an aid to promote prudent antibiotic use. KEY POINTS Diagnostic tests (point-of-care or tests analysed at the hospital laboratory), can increase diagnostic certainty and lead to a reduction in antibiotic use in general practice. A decrease in antibiotic courses in general practice in Denmark was observed during 2013–2017, while the use of diagnostic tests increased. A diagnostic test was performed in relation to 43% of antibiotic courses. Only 52% of prescribed fluoroquinolones was related to a diagnostic test, conflicting with national guidelines.

Antibiotic prescribing in Danish general practice in the elderly population from 2010 to 2017

Objective This study aimed to describe prescription of antibiotics to the elderly population in general practice in Denmark from 2010–2017. Design This is a national register-based observational study. Setting General practice, Denmark Main outcome measure The main outcome measure was prescriptions/1,000 inhabitants/day (PrID) in relation to year, age and sex, indication, and antibiotic agent. Subjects In this study, we included inhabitants of Denmark, ≥65 years of age between 01st July 2010–30th June 2017. Results A total of 5,168,878 prescriptions were included in the study. Antibiotic prescriptions decreased from 2.2 PrID to 1.7 (-26.9%, CI95% [-31.1;-22.4]) PrID during the study. The decrease in PrID was most noticeable among 65–74-year-olds (-25%). The ≥85-year-olds were exposed to twice as many PrID than the 65–74-year-olds, but only accounted for 20% of the total use. Urinary tract infection (UTI) was the most common indication for antibiotic prescription and increased with advancing age. The most commonly prescribed antibiotics were pivmecillinam and phenoxymethylpenicillin. Prescribing with no informative indication was present in one third of all cases. Conclusion The prescription of antibiotics in the elderly population in general practice decreased from 2010 to 2017. The oldest age group was exposed twice as frequently to antibiotic prescriptions as the 65–74-year-olds. The smallest reduction was observed for the ≥85-year-olds, suggesting targeting interventions at this group. Key Points High antibiotic use among elderly is well known and studies indicate mis- and overuse within this population. Our study shows. The prescription rate is decreasing within all age groups of the elderly population. The ≥85-year-olds receive twice as many prescriptions/1000/day as the 65–74-years-olds.